| NPI | 1144478512 |
|---|---|
| Doing Business As | GRENADA ADULT HEALTHCARE CLINIC PC. |
| Entity Type | Organization |
| Authorized Contact | JUSTICE AARON GONDWE President 662-227-6450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MS 20373) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 20373) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2008-08-29 |